{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:17:56Z","timestamp":1788877076442,"version":"build-2803163510"},"reference-count":15,"publisher":"SAGE Publications","issue":"1-2","license":[{"start":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T00:00:00Z","timestamp":1551398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Academic Forensic Pathology"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many nondrowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index (DI) has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. Studies have suggested DI may be useful in confirming drowning as the cause of death. No studies have yet compared autopsy findings in drownings to those in drug-related deaths, in spite of their qualitative similarities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We compared the lung and pleural effusion weight, spleen weight, and DI from 536 autopsies ruled drowning, opioid, or multidrug intoxication, or hanging in Columbia, Missouri, from 2011 to 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Opioid overdoses result in heavier lungs and spleens than drownings, multidrug overdoses, or hangings. There is no DI value at which a death can be definitively ascribed to drowning. The median DI was significantly higher in drownings than in opioid intoxications, multidrug intoxications, or hangings ( P &lt; .0001; P = .001; P = .005). However, very few drowning cases (13.33%) had a DI &gt;14.1. Additionally, many opioid and multidrug overdoses had a DI &gt;14.1. The highest calculated DI value (DI = 33) was associated with multidrug intoxication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In our opinion, the DI has little, if any, utility in distinguishing between drowning and drug-related deaths.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1925362119851115","type":"journal-article","created":{"date-parts":[[2019,9,6]],"date-time":"2019-09-06T07:36:10Z","timestamp":1567755370000},"page":"44-50","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Application of the Drowning Index to Opioid &amp; Multidrug Intoxication Deaths: A Retrospective Analysis"],"prefix":"10.1177","volume":"9","author":[{"given":"Lindsey T","family":"Ellis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Opsahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deiter J.","family":"Duff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl C.","family":"Stacy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,9,6]]},"reference":[{"key":"bibr1-1925362119851115","unstructured":"Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health & Human Services; c2019. Web-based injury statistics query and reporting system (WISQARS); [cited 2012 May 3]. Available from: http:\/\/www.cdc.gov\/injury\/wisqars."},{"key":"bibr2-1925362119851115","unstructured":"Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health & Human Services; c2019. CDC WONDER; [cited 2018 Nov 5]. Available from: http:\/\/wonder.cdc.gov."},{"key":"bibr3-1925362119851115","unstructured":"Missouri boating statistics & drownings [Internet]. Jefferson City (MO): Missouri State Highway Patrol; 2016 [cited 2018 Nov 5]. 22 p. Available from: http:\/\/www.mshp.dps.missouri.gov\/MSHPWeb\/SAC\/pdf\/2017BoatingAndDrowningStats.pdf."},{"key":"bibr4-1925362119851115","doi-asserted-by":"crossref","unstructured":"Zhu BL, Quan L, Li DR, et al. Postmortem lung weight in drownings: a comparison with acute asphyxiation and cardiac death. Leg Med (Tokyo). 2003 Mar; 5(1):20\u20136. PMID: 12935646. https:\/\/doi.org\/10.1016\/s1344-6223(02)00172-4.","DOI":"10.1016\/S1344-6223(02)00172-4"},{"key":"bibr5-1925362119851115","doi-asserted-by":"crossref","unstructured":"Yorulmaz C, Arican N, Afacan I, et al. Pleural effusion in bodies recovered from water. Forensic Sci Int. 2003 Sep 9; 136(1-3):16\u201321. PMID: 12969616. https:\/\/doi.org\/10.1016\/s0379-0738(03)00226-3.","DOI":"10.1016\/S0379-0738(03)00226-3"},{"key":"bibr6-1925362119851115","doi-asserted-by":"crossref","unstructured":"Christe A, Aghayev E, Jackowski C, et al. Drowning-post-mortem imaging findings by computed tomography. Eur Radiol. 2008 Feb; 18(2):283\u201390. PMID: 17763853. https:\/\/doi.org\/10.1007\/s00330-007-0745-4.","DOI":"10.1007\/s00330-007-0745-4"},{"key":"bibr7-1925362119851115","doi-asserted-by":"crossref","unstructured":"Lundemose S, Jacobsen C, Jakobsen S, Lynnerup N. Exact volumetric determination of fluid in the paranasal sinuses after drowning. J Forensic Radiol Imaging. 2015 Jun; 3(2):111\u20136. https:\/\/doi.org\/10.1016\/jjofri.2015.02.003.","DOI":"10.1016\/j.jofri.2015.02.003"},{"key":"bibr8-1925362119851115","doi-asserted-by":"crossref","unstructured":"Zivkovic V, Babic D, Nikolic S. Svechnikov\u2019s sign as an indicator of drowning in immersed bodies changed by decomposition: an autopsy study. Forensic Sci Med Pathol. 2013 Jun; 9(2): 177\u201383. PMID: 23269532. https:\/\/doi.org\/10.1007\/s12024-012-9397-z.","DOI":"10.1007\/s12024-012-9397-z"},{"key":"bibr9-1925362119851115","doi-asserted-by":"crossref","unstructured":"Nishitani Y, Fujii K, Okazaki S, Imabayashi K, Matsumoto H. Weight ratio of the lungs and pleural effusion to the spleen in the diagnosis of drowning. Leg Med (Tokyo). 2006 Jan; 8(1):22\u20137. PMID: 16157496. https:\/\/doi.org\/10.1016\/j.legalmed.2005.08.001.","DOI":"10.1016\/j.legalmed.2005.08.001"},{"key":"bibr10-1925362119851115","doi-asserted-by":"crossref","unstructured":"Sugimura T, Kashiwagi M, Matsusue A, et al. Application of the drowning index to actual drowning cases. Leg Med (Tokyo). 2010 Mar; 12(2):68\u201372. PMID: 20110191. https:\/\/doi.org\/10.1016\/j.legalmed.2009.11.006.","DOI":"10.1016\/j.legalmed.2009.11.006"},{"key":"bibr11-1925362119851115","doi-asserted-by":"crossref","unstructured":"Wardak K, Buchsbaum R, Walyzada F. The Drowning Index: implementation in drowning, mechanical asphyxia, and acute myocardial infarct cases. J Forensic Sci. 2014 Mar; 59(2):399\u2013403. PMID: 24528098. https:\/\/doi.org\/10.1111\/1556-4029.12356.","DOI":"10.1111\/1556-4029.12356"},{"key":"bibr12-1925362119851115","doi-asserted-by":"crossref","unstructured":"Noppen M, De Waele M, Li R, et al. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage. Am J Respir Crit Care Med. 2000 Sep; 162(3 Pt 1):1023\u20136. PMID: 10988124. https:\/\/doi.org\/10.1164\/ajrccm.162.3.9910050.","DOI":"10.1164\/ajrccm.162.3.9910050"},{"key":"bibr13-1925362119851115","first-page":"492","volume-title":"Forensic pathology: principles and practice","author":"Matshes EW","year":"2005"},{"key":"bibr14-1925362119851115","doi-asserted-by":"crossref","unstructured":"Pattinson KT. Opioids and the control of respiration. Br J Anaesth. 2008 Jun; 100(6):747\u201358. PMID: 18456641. https:\/\/doi.org\/10.1093\/bja\/aen094.","DOI":"10.1093\/bja\/aen094"},{"key":"bibr15-1925362119851115","doi-asserted-by":"crossref","unstructured":"Haffner HT, Graw M, Erdelkamp J. Spleen findings in drowning. Forensic Sci Int. 1994 Jun 3; 66(2):95\u2013104. 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